Kidney transplantation (KTx) is the preferred mode of renal replacement therapy for children with end stage renal disease. Although patient survival has come to a good point thanks to modern immunosuppression, acute graft dysfunction (AGD) are frequent especially in the first year of KTx.In this article, we aim to present the etiologic factors of AGD during the first year in children with KTx.

Material and methods:

Records of 56 pediatric KTx recipients (mean age of KTx: 14±3 years) performed at our institution between March 2005 and October 2017 were evaluated. AGD was defined as an acute increase in creatinine levels by % 25 or more compared to baseline. Etiologic factors and clinical features of AGD during the first year in our patients with KTx were analyzed.

Results:

During this period, 25 (44.6%) patients (10 deceased and 15 living donors, male and female ratio of 17/8) had diagnosed with AGD 30 times. 5 (20%) patients were admitted two times in a year with AGD. 4 (16%) patients were diagnosed with DGF The median time of AGD patients were 5 (mean: 4.12±2.31) months after transplantation. Nonimmunologic factors (90%) are the most common cause of AGD. The etiology of AGD showed, 8 (26.7%) patients cyclosporine toxicity, 7 (23.3%) patients dehydration, 5 (16.7%) BK nephropathy, 5 (16.7%) urinary tract infection, 1 (3.3%) CMV nephropathy and 1 (3.3%) obstructive uropathy. 12 patients had performed renal allograft biopsy. The histological findings were consistent with viral nephropathy in 5 patients, T cell mediated rejection in 2, B cell mediated rejection in 1 and nonspecific findings were determinate in 5 patients. Renal function improved with appropriate treatment in all patients. There was no loss of graft in any patient.

Conclusions:

If AGD during the first year in children with KTx are diagnosed early and treated appropriately, graft functions could be recovered.